BRAIN TUMORS

Brain Tumors
 Localized intracranial lesion that occupies space within the skull.
 Usually grow as spherical mass, but they can grow diffusely and
infiltrate tissue.
 The effects of neoplasms occur from the compression &
infiltration of tissue.
 A variety of physiological changes result, causing any or all of
the following pathophysiologic events such as:
 Increased ICP & cerebral edema
 Seizure activity & focal neurologic signs
 Hydrocephalus
 Altered pituitary function
Types
1. Primary - arise from tissues within the brain.
2. Secondary – results from a metastasis from a
malignant neoplasm elsewhere in the body.
- the most common type
Note: Brain tumors are generally classified according
to the tissue from which they arise.
Primary Brain Tumor
 Originates from cells & structures within the brain
 Cause is unknown

 The only known risk factor is exposure to ionizing radiation.

 Possible causes have been investigated but results of studies

are conflicting & unconvincing such as:

> use of cellphones
> exposure to high-tension wires
> use of hair dyes
> head trauma
> dietary exposure to such factors as nitrates (found in some
processed & barbecued foods)
Secondary or Metastatic Brain Tumors
 Develop from structures outside the brain
 Occur in 20% to 40% of all patients with cancer.
 Rarely metastasize outside the CNS, but metastatic
lesions to the brain occur commonly from lung,
breast, LGI tract, pancreas, kidney & skin
(melanomas)
 Brain Tumors may be classified into several groups

1. those arising from the coverings of the brain (eg. dural

meningioma)
2. Those developing in or on the cranial nerves (eg.
Acoustic neuroma)
3. Those originating within brain tissue (eg. Gliomas)
4. Metastatic lesion originating elsewhere in the body.
5. Tumors of the pituitary & pineal gland & of cerebral
blood vessels are also types of brain tumors.
6. Tumors maybe benign or malignant ( a benign tumor can
occur in a vital area and can grow largely enough to have
effects as serious as those of malignant tumor.
 Classification of Adult Brain Tumor
I. Intracerebral Tumors
A. Gliomas – infiltrate any portion of the brain;
most common type of brain tumor. Originates in
astrocytes.
1. Astrocytomas (grades I & II) can range
from low-grade to moderate-grade malignancy.
Tissue of origin: supportive tissue, glial cells
& astrocytes
2. Glioblastoma multiforme (astrocytoma
grades III and IV) Highly malignant & invasive;
among the most devastating of primary tumors.
Tissue of origin: Primitive stem cell (glioblast).
3. Oligodendrocytoma (Oligodendroglioma)(low
& high grades) Benign (encapsulation &
calcification)
Tissue of origin: Oligodendrocytes
4. Ependymoma (grades I & IV) Range from
benign to highly malignant; most are benign &
encapsulated.
Tissue of origin: Ependymal epithelium
5. Medulloblastoma – highly malignant &
invasive; metastatic to spinal cord & remote
areas of brain.
II. Tumors Arising from supporting
structures
a. meningiomas – can be benign or
malignant; most are benign.
 Represent 20% of all primary brain tumors.
 Slow-growing & common in women at
middle age adult.
 Standard treatment is surgery with complete
removal or partial dissection.
Tissue of origin: meninges
b. neuromas (acoustic neuroma, schwannoma) many grow on
both sides of the brain; usually benign or low-grade malignancy.

Acoustic neuroma – tumor of the eight cranial nerve (responsible

for hearing & balance)
 grow slowly & attain considerable size before it is correctly
diagnosed.
 Patient usually experiences loss of hearing, tinnitus, &
episodes of vertigo & staggering gait.
 As the tumor becomes larger, painful sensations of the face
may occur due to the compression of the fifth cranial nerve.
Tissue of origin: cells that form myelin around nerves;
commonly affects cranial nerve VIII
c. pituitary adenomas – usually benign
 Represent about 8% to 12% of all brain tumors
 The pituitary gland, also called hypophysis, is a relatively small gland located
in the sella turcica.
 Attached to the hypothalamus by a short stalk (hypophyseal stalk) and is divided
into two lobes: the anterior (adenohypophysis) and the posterior
(neurohypophysis).
 Pressure effects on the optic nerves, optic chiasm, or optic tracts or on the
hypothalamus or third ventricle results into:
- headache
- visual dysfunction
- hypothalamic disorders ( disorders of sleep, appetite, temp &
emotions)
- increased ICP
- enlargement & erosion of the sella turcica
- hormonal effects
Tissue of origin: Pituitary gland
Hormonal Effects of Pituitary Adenomas

 Amenorrhea or galactorrhea (excessive or

spontaneous flow of milk) due to excessive
secretion of prolactin by the pituitary gland for
the female patient.
 Impotence & hypogonadism for male patients
with prolactinomas.
 Acromegaly caused by excess growth
hormone,
> produces enlargement of the hands & feet
> distortion of the facial features
> pressure on the peripheral nerves
Hormonal Effects of Pituitary Adenomas

 Clinical features of Cushing’s disease ( a

condition associated with prolonged
overproduction of cortisol, occur with
excessive production of ACTH;
 obesity with redistribution of fat to the facial,
supraclavicular & abdominal areas
 hypertension
 purple striae & ecchymoses
 osteoporosis
 elevated blood glucose levels
 emotional disorders
III. Developmental tumors
a. angiomas – massess composed largely of abnormal blood
vessels.
- occur in the cerebellum in 83% of cases
- some persist throughout life without symptoms; others cause
symptoms of a brain tumor
- patients are at risk for cerebral vascular accident (stroke),
because the walls of the blood vessels are thin.
b. dermoid, epidermoid, teroma, craniopharyngioma
IV. Metastatic lesions
CLINICAL MANIFESTATIONS
 Headache – worse at night & may awaken the patient
- usually constant but occasionally throbbing.
 Seizures
 Nausea & vomiting from increased ICP
 Cognitive dysfunction including memory problems & mood or personality
changes.
 Muscle weakness
 Sensory losses
 Aphasia
 Visuospatial dysfunction
 Increased ICP
 Cerebral edema
 Obstruction of the CSF pathways
Tumor Location & Presenting Manifestations

 Cerebral Hemisphere
 Frontal lobe (unilateral)
unilateral hemiplegia
seizures
memory deficit
personality & judgment changes
visual disturbances
 Frontal Lobe (bilateral)
same as above; ataxic gait
 Parietal Lobe
Speech disturbance (if tumor is in the dominant
hemisphere: inability to write, spatial disorders,
unilateral neglect)
Occipital Lobe
Blindness & seizures
Temporal lobe
Few symptoms; seizures & dysphagia
 Subcortical
 hemiplegia
 other symptoms may depend on area of infiltration
 Meningeal Tumors
 symptoms are associated with compression of the brain
& depend on tumor location
 Metastatic Tumors
 headache, n/v because of ↑ICP, others depend on tumor
location
 Thalamus & sellar tumors
 headache, nausea, vision disturbances,papilledema &
nystagmus occur from ↑ICP, diabetes insipidus may
occur
 Fourth ventricle & cerebellar tumors
 headache, nausea, & papailledema from ↑ICP; ataxic gait
& changes in coordination, Tinnitus & vertigo &
deafness
 Braistem Tumors
 Headache on awakening, drowsiness, vomiting, ataxic
gait, facial muscle weakness, hearing loss, dysphagia,
dysarthria, “crossed eyes” or other visual changes,
hemiparesis
COMPLICATIONS
 Hydrocephalus
- if the tumor mass obstruct the ventricles or
occludes the outlet.
 Surgical treatment- ventriculoatrial or
ventriculoperitoneal shunt, in which a catheter with
one-way valves is placed in the lateral ventricle &
then tunneled through the skin to drain CSF into the
right atrium or the peritoneum.
 Signs of Increased ICP
decreasing LOC
restlessness
headache
blurred vision
vomiting without nausea
 Signs of infected shunt
high fever
persistent headache
stiff neck
DIAGNOSTIC STUDIES
 MRI & PET allows for detection of very small tumors & may
provide more reliable diagnostic information.
 CT and brain Scanning – used to diagnose the location of the
lesion
 SPECT (single photon emission computed tomography)
 EEG useful but less importance
 Lumbar puncture – seldom diagnostic & carries with it the
risk of cerebral herniation
 Angiography – used to determine blood flow to the tumor &
further localize the tumor
 Endocrine Studies – helpful when pituitary adenoma is
suspected
 Histologic study ( smear or frozen section)
Collaborative Care
 Treatment goals are aimed at
 Identifying the tumor type & location
 Removing or decreasing tumor mass
 Preventing or managing increased ICP
 Surgical removal is the preferred treatment for
brain tumors.
 Radiation therapy & Radiosurgery
 Chemothedirectlyrapy: methotrexate, procarbazine
temodar ( firs oral chemotherapeutic agent found to
cross the blood-brain barier..
Nursing Diagnosis
 Impaired tissue perfusion (cerebral) related to cerebral edema
 Acute pain (headache) r/t cerebral edema and increased ICP
 Self-care deficits r/t neuromuscular fuction secondary to
tumor growth & cerebral edema
 Anxiety r/t diagnosis & treatment
 Potential complication: seizures r/t abnormal electrcal activity
of the brain
 Potential complication: increased ICP r/t presence of tumor &
failure of normal compensatory functinong.
THANKS!!!